ag ik a ae ea 8 
743 
and congested. Here and there the connective tissue of the intra-alveolar septa 
is increased. Many of the alveoli contain desquamated cells and granular detritus. 
In the spleen the pulp spaces are much crowded with red blood corpuscles, among 
which are a moderate number of leucocytes. The follicles are not sharply defined, 
the trabecule are thin, the connective tissue in general is not increased. Both 
in the pulp spaces and in the follicles a considerable amount of extra- and intra- 
cellular dark-brown pigment is encountered. Parasites of wstivo-autumnal 
malaria are fairly numerous. In the liver, the interlobular capillaries are dilated 
and filled with blood. The parenchyma cells show some fatty and well-marked 
cloudy changes. The most prominent histologic deviation from the normal type 
is found in the interlobular connective tissue. Here we see a periportal inflam- 
matory infiltration composed of small, round lymphoid cells, some ordinary 
polynuclear and quite a few eosinophilic cells. Fine, dark, pigment granules 
are seen all through the hepatic sections while the interlobular foci also show 
coarser pigment granules. In these foci malarial parasites are likewise encoun- 
tered. The renal sections show cloudy swelling of the tubular epithelia, with much 
granular material; otherwise there are no marked changes. In the stomach, the 
mucosa, which is otherwise normal, shows a moderate eosinophilia. In the mucosa 
of the small intestine very large numbers of polynuclear eosinophiles are present. 
These cells are found throughout the mucosa; they extend into the muscularis 
mucose and into the surrounding, loose connective tissue. The popliteal nerve 
and its branches show but a very moderate degree of degeneration of the myelin 
sheath, but some is undoubtedly present. 
Case No. 7.—Acute beriberi complicated by malaria.—Necropsy No. 1674, March 
7, 1906: Post-mortem examination at St. Paul’s Hospital on the body of Okumura 
Kakuzo, a Japanese, 18 to 20 years old. This man had been under observation 
while sick at the hospital for two or three days. Absence of the patellar reflex, 
paresis of the lower extremities and dyspnoea had been noted. A blood examina- 
tion showed malarial parasites of the stivo-autumnal type. A few ova of 
uncinaria duodenale were found upon examination of the stools. Clinical diag- 
nosis, beriberi complicated by malaria. .The patient died March 6 at 8.30 p.m. 
AvutTopsy.—Twenty hours after death: The body is that of a well-developed, 
rather strong Japanese, well nourished, no anomalies. The anterior tibial sur- 
faces of the legs show a few, shallow cicatrices. Rigor mortis, well marked. 
Posterior surface of the body shows extensive areas of lividity. The important 
lesions observed may be summarized as follows: The pericardial fluid is increased, 
the heart is hypertrophied, and the wall of the right ventricle has a thickness 
of from 6 to 8 millimeters. The consistency of the myocardium is normal; the 
color is pink, with a few yellowish spots. The lungs are edematous, but other- 
wise normal. The spleen weighs about 450 grams. It is dark, purplish-gray 
externally, and on section, of a light-reddish-brown color. The pulp is very soft 
and protrudes over the cut surface. Follicles and trabecule are not easiiv 
distinguished. The liver is large, swollen, grayish-pink in color with numerous 
yellow dots. On the cut surface it is dull grayish-pink and the veins discharge 
a considerable quantity of blood. The kidneys ave normal in size, the capsules peel 
off easily, and the cut surface shows a peculiar rose or pink color. The mucosa of 
the stomach and duodenum is moderately hyperemic. Otherwise the internal 
organs are normal. No uncinaria are found in the small intestine. 
ANATOMICAL DIAGNOSIS.—Moderate hydropericardium, hypertrophy of the myo- 
cardium, adema of the lungs, enlargement, congestion and softening of the spleen, 
hyperamia of the kidneys, congestion, fatty and parenchymatous degeneration 
of the liver, hyperemia of the gastric and duodenal mucosa, acute pernicious 
beriberi. 
